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December 6, 1995

Myocardial Injury in Critically III Patients-Reply

Author Affiliations

Washington University School of Medicine St Louis, Mo
State University of New York Health Science Center at Syracuse College of Medicine

JAMA. 1995;274(21):1672-1673. doi:10.1001/jama.1995.03530210026017

In Reply.  —We are pleased to have the opportunity to clarify several important issues raised by the letters of Dr Beck and Drs Fromm and Varon.We did use cardiac troponin I as the "gold" standard for our study but only after a series of studies referenced in the article showed that (1) cardiac troponin I is only found in heart muscle during adult life and embryogenesis; (2) cardiac troponin I is not expressed in response to skeletal muscle injury; (3) the antibodies used in the assay for cardiac troponin I do not cross-react with skeletal muscle troponin I; (4) cardiac troponin I is not elevated in patients with acute or chronic muscle disease, after endurance exercise, or in patients with renal failure who have elevated levels of MB creatine kinase fraction unless concomitant cardiac injury is present; (5) elevations of cardiac troponin I correlate closely with evidence of myocardial

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